Medication management systems and methods for health and health related facilities

ABSTRACT

A system and method for control of prescription drug packaging and dispensing machines located in an in-patient health care facility including centralized control and enhanced communication between system components. Delay and errors in processing item data in the prescription dispensing system are reduced by using concise ID data incorporated into each canister memory chip and storing canister contents data elsewhere. Canisters are configured in a pharmacy using interchangeable parts. Data being processed is synchronized by a combination of user tokens (who), data identifiers (what), and unique Ids for the entities in the system (where). The foregoing combination enables substantial efficiency improvements and error reduction.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/050,460 filed Feb. 22, 2016, which is a continuation of U.S. patentapplication Ser. No. 13/085,298 filed Apr. 12, 2011, which claimspriority to U.S. Provisional Patent Application No. 61/323,125 filed onApr. 12, 2010, all of which are hereby incorporated by reference for allpurposes.

TECHNICAL FIELD

The disclosure generally relates to medication delivery in health andhealth related facilities using automated pharmacy dispensing systemsand more particularly to automated medication prescription anddispensing, inventory management and control, and information processingin facilities including but not limited to resident health carefacilities such as nursing homes, assisted living centers, retirementhomes and senior communities with health care facilities, long term carefacilities, prisons, and the like.

BACKGROUND

Management of automated prescription medication delivery in a residenthealth care facility, which may be referred to generally herein as along term care facility or LTC, particularly those with in-housepharmacies and/or dispensaries involves multiple participants and avariety of complex operations. These include communicatingprescriptions, dispensing medications as directed and on time, keepingaccurate and timely records of the medications dispensed, receiving newand replenishment prescriptions into a facility or pharmacy-controlledmanagement system, processing payment for the medications from a varietyof providers, managing and tracking the inventory of drugs to bedispensed, providing accurate and timely feedback about the dispensingand actual administration of the medication, stock levels and rates ofdispensing of the items in inventory, scheduling and requestingreorders, managing and monitoring of controlled substances, performingdrug interaction and allergy analyses, all with little or no centralizedcontrol system to facilitate management and ensure compliance withregulatory and standard operating procedures required for these diverseoperations.

These tasks must be performed accurately and efficiently to ensuresafety and security of the patients and their medications, and minimizeloss and waste of controlled substances and unused medications.

Traditional pharmaceutical delivery systems that employ written andspoken communication of information and hand-carried delivery arefrequently characterized by very substantial inefficiencies andopportunities for errors, occasionally with grave consequences. Atnearly every step of the way from writing a prescription, getting itfilled and records generated, delivering it to a long term health carefacility and providing for administration of the medication at theappointed time to the correct patient, opportunities for mistakes aboundbecause the process involves numerous people handling the records andthe medication for each instance of delivery and administration tofulfill the prescription. Further, the flow of information associatedwith management of the process takes place slowly, in serial fashion,and involves frequent handling of paper records.

In recent years a number of systems have been developed for use invarious kinds of in-patient or resident health care facilities toautomate the process. Automated dispensing machines have been developedto package and dispense medications to personnel tasked withadministering the medications to patients on predetermined schedulesaccording to the “script,” the instructions accompanying theprescription. Portions of the process may be brought under computercontrol to manage the flow of information. Although computers are usedto a substantial extent to handle the volume of data associated withdispensing prescription medications, the control and packaging of themedications, the patient records for the medications prescribed byphysicians, processing payment by third parties, etc., inefficienciesand the opportunities for errors and substantial waste remain.

One ongoing problem in many systems is the amount of time delay thatoccurs from the instant a prescription is issued by a physician untilthe initial dose is dispensed and administered to the patient. Theconsequences of delay and errors in administering the drugs prescribedcan be serious and even catastrophic. Accordingly there is a need forsystem and methods that minimize this delay and include controls thatminimize error in the processes involved in the delivery, management,dispensing and administering the medications.

Another problem with conventional systems is the lack of timely feedbackregarding the status of processes at each step from incomingprescription to administering the prescribed dose at the appointed time,and the inability of conventional systems to operate in aforward-looking mode, that is, to know what medications are needed inthe future according to present prescriptions so that inventory levelsmay be regulated and medications reordered and distributed to patientlocations before an out-of-stock condition occurs. Present systems are“reactive,” that is, they are designed to react to out-of stock or parlevel conditions. A consequence of the reactive operation is thatresidents may have to go without a dose at the prescribed time becausethe medication was not dispensed on time due to an out-of stockcondition caused by sudden increases in usage or improper inventorycontrol. A missed dose can have serious consequences to some residentsor patients. Thus, what is needed is a “proactive” system that knowswhen a supply of a medication will be emptied and provides fordistribution of the replenishment on a schedule that maintains thedispensing of the medications in an uninterrupted flow, even ininstances of sudden increases in usage.

A related problem with conventional systems is the opposite conditionwhen the processes of dispensing medications are not sufficientlycontrolled—i.e., inventory levels are not well-matched to prescriptionrequirements or the tracking of medications dispensed and administeredis insufficient. The result is substantial quantities of medicationsthat are not administered and must be discarded because, for safety andsecurity reasons, there is no provision for re-stocking the unusedmedications. This circumstance causes waste that requires controlledprocedures for destruction of the unused substances. Elimination of suchwaste would result in reduced costs to the long term care facilities,resident patients and their families, insurance providers and taxpayers,and enhance both safety and efficiency of the prescription process.

Yet another deficiency of existing systems is an inability of variousstations or functional entities of the system to interact with eachother or to be organized so that their functional operations arecoordinated to minimize lost opportunities to respond to current andanticipated conditions because prescription data is not available or thestatus of a dispensing process is not known, etc. Accordingly there is aneed for synchronizing the operations and processes in the system sothat process flows make use of all available data and are coordinatedwith each other to ensure efficient and accurate dispensing andadministering of medications. Especially important would be the abilityto provide direct communication between prescription and order entry andthe dispensing processes and apparatus, and the dispensing apparatus andthe records associated with dispensing and administering of themedications.

While the use of automated packaging and dispensing machines located inthe long term care facility or pharmacy may provide some efficiencies,and alleviate some of the bottlenecks, unless they are used to maximumadvantage, few of the aforementioned problems are actually solved. Theproblems are more in the nature of information flow than automating someportion of the packaging or handling of prescription medications. In oneexample the data that defined the identity and contents of each canisterin a dispensing machine occupied more than two kilobytes of data. Onetypical example of this prior art technique is illustrated in FIG. 1,which depicts the layout of the canister memory space 10 having a firstrow 12 specifying the byte population of the memory, a second row 14identifying the data stored in the memory 10, and a third row 16defining the hexadecimal address of the various items of data. Ofinterest are the data sections of the second row: canister ID 18 (3bytes), the Chip ID 20 (15 bytes), and, most significantly, the ChipMemory Data 22 that describes the prescription medication contained inthe canister (more than two kilobytes). When two kilobytes of data ismultiplied by several hundred times—the number of canisters in a typicaldispensing machine—the processing time takes on significant dimensions,becoming a substantial cause of processing delay, and dispensing errorsdue to the delay in processing the data in the prescription processingand dispensing operation.

In another example of the problems encountered when using automatedpackaging and dispensing machines, consider that in such systems thecontainers from which the medications are dispensed, often calledcanisters, must be available in a variety of sizes and configurations,each adapted to a particular physical size and shape of a medicationunit, pill, or tablet. The result is each medication can only becontained in one configuration of canister. Some medications having thesame formula are available in multiple sizes and shapes; others in onlyone size and shape; still other generic forms of the same drug,available from different manufacturers, may require a variety ofdifferent configurations. Further, the size and shape of medications aresubject to change. This variety of configurations complicates theprocess of determining the most efficient container or canisterconfiguration. The result can be inefficiency and compromise, which iswasteful of resources, more susceptible to errors, and often wasteful ofmedications because accommodating this variety is cumbersome,time-consuming, and expensive.

SUMMARY

Accordingly there is provided a system for controlling dispensing ofmedications in a health care facility coupled to a network, comprising:an order management system (OMS) and an associated database operating ona hosted (central) remote server coupled to said network, said OMSserving said health care facility via said network; a prescription orderentry (POE) system coupled via said network to said order managementsystem; a medication dispensing system installed in said health carefacility and coupled via said network to said order management system;and an electronic medication administering record (eMAR) coupled throughsaid medication dispensing system via said network to said ordermanagement system.

In another embodiment a method is provided for automated dispensing ofprescription medications to one or more health care facilities viaassociated remote pharmacies, comprising the steps of: providing acentral hosted remote server having a system database and coupled to anetwork and operating an order management system (OMS) containinginterface links to a plurality of remote operative units; providing atleast one medication dispensing system in each health care facility,wherein each said medication dispensing system includes an automatedprescription drug packaging and dispensing machine (ADM) and a workstation coupled thereto, and each said automated dispensing machine(ADM) is coupled to said central hosted server; coupling a prescriptionorder entry system (POE), accessible from said health care facility, tosaid central remote server via said network; including in said automateddispensing machine (ADM) a plurality of medication canisters for storingand dispensing prescription drugs therefrom; and associating with eachsaid canister a memory device having a storage capacity not exceeding 48bytes.

Further, a system for control of prescription drug dispensing isprovided comprising: a database and a prescription order entry (POE)system coupled respectively via a network to an order management system(OMS), said OMS serving an in-patient health care facility via saidnetwork; an automated drug packaging and dispensing machine (automateddispensing machine or ADM) installed in said health care facility andcoupled to said OMS; and an electronic medication administering record(eMAR) coupled to said OMS through said automated dispensing machine.

In other aspects, the automated dispensing machine comprises a cabinetcontaining a plurality of individually removable canisters for storingan inventory of prescription medications selected according toresident's needs; a processor responsive to communication with said OMSand said eMAR and configured for control of said canisters; and acanister memory associated with each canister and accessible to said OMSand said eMAR, said canister memory location containing a build code IDand a canister fill ID, wherein said build code ID comprises a coderepresenting a particular medication and a species thereof, and saidcanister fill ID comprises a code representing said canister and asuffix code representing each instance of filling said canister.

In another aspect, the system further comprises a mechanism forpackaging a medication for a patient and a mechanism for dispensing saidmedication to a patient care worker.

In another aspect, the system further comprises a computing devicehaving a display and data entry provision for requesting dispensing ofand recording administration of a prescription medication to a residentpatient.

In another aspect, the computing device further comprises a scanningdevice for reading an encoded label.

In an alternate embodiment, a method is provided for dispensingprescription drugs in a health care facility, comprising the steps ofstocking an automated dispensing machine (ADM) installed at said healthcare facility and linked to an order management system (OMS); enteringpatient prescription information into a prescription order entry (POE)system in communication with said order management system; compiling acomprehensive patient medication record in an electronic medicationadministration record (eMAR) contained in a handheld eMAR device coupledto said ADM; and linking said eMAR through said ADM to said OMS.

In another aspect, the method comprises the steps of updating said eMARwith each dispensing operation from said ADM; and updating a databasecoupled to said OMS according to said eMAR.

In another aspect, the method comprises the step of updating a re-orderqueue according to said data stored in said database coupled to saidOMS, including scanning label information from said eMAR device forentry into said eMAR.

In yet another alternate embodiment, a method is provided for reducingdelay in processing item data in an inventory control system, comprisingthe steps of formatting a data transfer message to exclude said itemdata to be transferred; limiting the contents of said data transfermessage to a build code identification statement and a canister fillidentification code statement; and storing said item data to betransferred in a database location identified by said build codestatement, wherein said build code identification (ID) comprises a coderepresenting a particular stock item and a species thereof, and saidcanister fill identification (ID) comprises a code representing saidcanister and a suffix code representing each instance of filling saidcanister.

In an alternate embodiment a method for coordinating the processing ofdata items among participating entities in the system wherein the databeing processed is synchronized by a combination of user tokens (who),data identifiers (what), and unique Ids for the entities in the system(where).

DESCRIPTION OF THE FIGURES

The accompanying drawings facilitate an understanding of the variousembodiments:

FIG. 1 illustrates one example of a prior art memory format forprescription medications;

FIG. 2 illustrates an example of a more efficient memory format for aprescription medication according to at least a first embodiment asdisclosed herein;

FIG. 3 illustrates a front perspective pictorial view of a medicationcanister for a dispensing machine for use in at least the firstembodiment as disclosed herein;

FIG. 4 illustrates a rear perspective pictorial view of the medicationcanister of FIG. 3;

FIG. 5 illustrates a general system block diagram according to oneembodiment disclosed herein;

FIG. 6 illustrates a system block diagram according to a variation ofthe embodiment of FIG. 5;

FIG. 7 illustrates a system block diagram of the basic architecture ofone embodiment disclosed herein;

FIG. 8 illustrates an automated prescription dispensing machine and anassociated work station disclosed herein, for use with the embodimentsof FIGS. 2 through 7;

FIG. 9A illustrates a first portion of a flow chart for the basicoperation of the system of FIGS. 6 and 7;

FIG. 9B illustrates a second portion of the flow chart for the basicoperation of the system of FIGS. 6 and 7;

FIG. 10 illustrates a flow chart of one embodiment of a process 280 forformulary substitution as disclosed herein;

FIG. 11A illustrates a flow chart of initial steps to begin a medicationcanister configuration and fill process according to at least oneembodiment as disclosed herein;

FIG. 11B illustrates a flow chart of a process to create a canisterbuild as disclosed herein;

FIG. 11C illustrates a flow chart of a process to configure a canisteras disclosed herein;

FIG. 11D illustrates a flow chart of a process to fill a canister asdisclosed herein;

FIG. 11E illustrates a flow chart of a process to add a medicationcanister as disclosed herein;

FIG. 11F illustrates a flow chart of a process to edit a medicationcanister as disclosed herein;

FIG. 12 illustrates a flow chart of a process to prepare medications foradministering them to residents of a long term care facility asdisclosed herein;

FIG. 13 illustrates a flow chart of a process for administeringmedications to residents of a long term care facility as disclosedherein; and

FIG. 14 illustrates a simplified flow diagram for reading medicationdata from a canister memory as disclosed herein.

DETAILED DESCRIPTION

In the following detailed description of the present invention, variousstructural components illustrated in the drawings will be identified bya reference number. When the same component appears in more than onefigure, the same reference number will generally be used. However, insome cases, such as when the embodiment is a different one, a differentreference number may be used in a particular drawing. The description isto be read in conjunction with the drawings. The term health carefacility as used herein may mean any facility that provides health care.The facility may include dispensing of medications to patients orresidents of the facility. Examples include long term care facilities,nursing homes, prisons, certain hospitals, retail facilities, and thelike. The term “dispensing machine” is used synonymously with “automatedprescription drug dispensing machine” and “automated dispensing machine(ADM).”

The invention to be described herein concerns automated pharmacydispensing systems and methods. Disclosed herein are a number ofdistinct embodiments including: (1) a system for control of prescriptiondrug dispensing comprising a novel combination of an automatedprescription drug packaging and dispensing machine in a health carefacility plus off-site management and control coordinated by a mainserver coupled via a global communications network to the operatingentities in the system; (2) a method for dispensing prescription drugsin a health care facility, that is, the use of the novel systemidentified above; (3) a method for reducing delay in processing data ina prescription drug order and dispensing system of a health carefacility that relies in part on re-defined contents of data that isincorporated into each canister installed in the packaging anddispensing machine of the system; and (4) a method for coordinating orsynchronizing the operating entities in the system with respect to thedata being processed during the operation of the above prescription drugdispensing system. The synchronization system ensures that all entitiesin the system, including the stations or kiosks in the health carefacilities connected to the network, are operating on the correct data.In addition, (5) the system is fully scalable and can accommodatemultiple health care facilities, multiple pharmacies, and multipleautomated dispensing machines in each health care facility.

In a first illustrative embodiment, the overall system is illustrated inschematic block diagram form in FIG. 5, which shows the basic structureof the system as depicted by its primary operating components. Ingeneral, the system may accommodate multiple health care facilities suchas long term care facilities (LTCs) and pharmacies, all connected to amain server operated by a hosting center as a typical example. FIG. 6presents a similar schematic block diagram showing the structures of thelong term care facilities and the pharmacies, and the functionalrelationships among the operating entities and components of the system.FIG. 7 illustrates in block diagram form the architectural relationshipsof the functional components of the system. As will be explained, theportions of FIG. 7 having a bold line outline depict new structurescreated specifically for the present invention. FIG. 8 depicts aprescription drug dispensing system that includes one form of anautomated prescription drug packaging and dispensing machine, which willoften be referred to as an automated dispensing machine (ADM) herein,and a kiosk or work station equipped with a PC or server, a scanner, andoptionally, a printer.

In a second embodiment, FIGS. 9A and 9B depict a basic operation of thesystem. FIGS. 10 through 14 illustrate other basic aspects of themethods of using the system of FIGS. 5, 6, 7 and 8 to dispenseprescription medications in a health care residence or facility. Some ofthese operating relationships may be understood by referring to FIGS.11A through 11F. Several specific communicating links and signal flowsin FIG. 7 that represent new flows of information in pharmaceuticalmanagement processing systems are depicted by highlighted lines.

In a third embodiment shown in FIG. 2, reduction of the data content ofthe canister memory chip to the combination of a build code ID and acanister fill ID, each requiring only relatively small amounts of data,enables a very substantial reduction in processing time resulting inmuch less inherent delay in processing the system inventory, thetracking of dispensing problems, and the dispensing of prescriptions andprescription information. The canisters themselves are described inFIGS. 3 and 4, and the process of using the modified canister system isillustrated in FIG. 8. Detailed data regarding the prescription druginformation associated with the build code ID and the canister fill IDis stored in the main database accessed by the management system andreferred to only as needed.

The build code ID may comprise a four digit code representing thestructural configuration (stored in a database) of the canister that iscompatible with a particular group of medications. Medications aresupplied in a large variety of forms, sizes, shapes, etc.(“attributes”). The structural components of each canister are adaptedto accommodate a particular group of such attributes. The canister fillID may comprise a 12 digit code that uniquely identifies the canister.In one example, the code may represent when (the date and time) thebuild code ID is first assigned and a three digit suffix coderepresenting each instance of filling said canister with saidmedication. Other data associated with the canister fill ID may bestored in a database location corresponding to the canister fill ID.Other code types or length for the build ID and canister fill ID codesmay be used in variations of the exemplary embodiment described herein.

In a fourth embodiment, a method for coordinating data being processedby the various entities in the system is provided through assignment ofID information to enable synchronization of the data of the variousstations on the network as needed. It is this coordination process thatenables the system communication efficiencies leading to substantiallyimproved processing speed and the ability to proactively manage theforward-looking inventory control aspects of the system.

Beginning with the detailed description, FIG. 2 illustrates an exampleof a more efficient canister memory format for a prescription medicationaccording to at least one embodiment disclosed herein. The figuredepicts the layout of the canister memory space 30 as disclosed hereinhaving a first row 32 specifying the byte population of the memory ineach of the identified groups, a second row 34 describing the datacontent stored in the memory 30, and a third row 36 defining thehexadecimal value ranges of the various items of data. Of interest arethe data content sections of the second row: a Build ID 38 (3 bytes),and the Canister/Fill ID 40 (15 bytes). It is important to notice thatthe “Chip Memory Data 22” of the prior art, which used in excess of2,000 bytes of data is no longer stored in the canister memory 30. Thisis because the inventor realized that such detailed information aboutthe prescription drug contained in the canister, which occupied morethan two kilobytes of data, no longer needed to be stored in thecanister itself. This data may be stored in a database location andaccessed as needed outside the most important real time sequences foroperation of the system as will be subsequently described. The result ofthis insight is a very substantial reduction in processing time leadingto a major improvement in efficiency and responsiveness of the system tothe needs of the health care facility.

FIG. 3 illustrates a front perspective pictorial view of a medicationcanister for an automated prescription drug dispensing machine (ADM) foruse in the illustrative embodiment of the present invention. Thecanister 50 may be assembled from interchangeable parts including atransparent main body 52 that includes a transparent hopper section 54,a lid 56, a memory receptacle 58, a memory chip 60, a division block 62with drive hub 64, and a security tape 66. The division block 62 is arotating distributor that indexes one position for each medication pill,tablet or capsule to be dispensed. The rotation is provided by a drivemechanism within the dispensing machine to be described that is coupledto the drive hub 64. The drive hub 64 has an internal spline to engagethe drive shaft of the dispensing machine in a non-slip manner. Theengagement of the drive shaft and the splined drive hub 64 occurs whenthe canister 50 is selected for dispensing and moved into position inengagement with the drive mechanism. Others of the interchangeable partsof the canister 50 will be described for FIG. 4.

The canister 50 may include a detailed medication fill label 68 attachedto the lid 56 of the canister with printed specifications of theprescription drug medication and a machine-scannable portion ofinformation 69 such as a bar code or the like. The canister fill label68 may further include a duplicate machine-scannable portion ofinformation 69 wrapped over the upper front edge of the canister asshown to enable scanning the label when the canister is installed in adispensing machine. The canister may further include a build label 70that has a four digit build code 72 and bar coded build information 74.The build label 70 is preferably printed when the canister 50 isconstructed and may be permanently affixed to the canister 50 throughoutits life. The build information is scanned whenever the canister ishandled so that the system always knows the identity and location of thecanister and can thereby reference its contents with databaseinformation whenever the build label 70 is scanned. The medication filllabel 68 is preferably printed and affixed to the canister 50 each timethe canister is prepared for installation in an automated dispensingmachine. Locating the scannable build code label 70 on the front, handleportion of the canister facilitates rapid identification and logging ofthe canister regardless of where it is in the system or how it is beinghandled. The canisters are prepared in a pharmacy, which may usually belocated at the health care facility or off-site, following anymaintenance on the canister before use or reuse. Maintenance may includeremoval of old labels, replacement of worn or broken parts, inspection,cleaning, etc. before restocking for reuse. In some cases the canistersmay be modified or configured to accommodate different medicationattributes—that is, different form, shapes, and sizes of the tablet,pill or capsule that will be stored therein for dispensing. A new buildID is assigned to the canister when it is reconfigured.

FIG. 4 illustrates a rear perspective pictorial view of the medicationcanister 50 of FIG. 3. In this view from slightly below the canister 50the main body 52, transparent portion 54 and lid 56 remain visible,along with the division block 62, the drive hub 64, the memoryreceptacle 58 and the memory chip 60. The memory chip 60 may preferablybe a printed circuit board component having connection traces on one ofboth of its faces for mating with corresponding conductors when insertedinto a receptacle as the canister is installed in the dispensingmachine. Thus, the memory chip 60 is connected into the circuitry of thedispensing machine so that its contents may be read during operation ofthe machine to access the canister (i.e., bring it into a dispensingposition), dispense a unit (or the required number of units) into apackage, and arrange the packages in a predetermined sequence fordispensing to the person who will administer the medication to theresident intended to receive the unit(s) of medication. Although thisprocess is generally operated under programmed control the facility maydispense medications whenever it chooses, for example in PRN or demandcircumstances.

Also visible in FIG. 4 are a partition 76, a partition fix block 78, anda guide block 80. The partition 76 is a flexible arm, fixed to the fixblock with screws as shown. The fix block 78 includes several threadedholes to permit adjustment of the partition 76 in a vertical directionrelative to the lower portion of the division block 62. The flexible armincludes a small tab (not shown) on the side of the partition 76 facingthe division block 62 and acts to assist in dispensing a unit ofmedication during operation of the dispensing machine. The guide block80 is fixed to the underside of the main body 52 of the canister andacts as a key to locate in the transport mechanism (not shown) of thedispensing machine. The transport mechanism can accommodate severaldifferent sizes (capacities) of canisters, each with its own keyedreceptacle to match the guide block 80 of the appropriate canister 50.The interchangeable parts of a canister 50 may include at least the mainbody 52, the division block 62, the partition 76, and the guide block80.

The canisters illustrated in FIGS. 3 and 4 may generally contain a 10 to30 day supply of prescription medications of an individual resident orpatient of a health care facility. The quantity of medications dependsstrongly on their costs, so the costs of maintaining an inventory is animportant consideration. The system may accommodate supplies of up to 90days if needed. In one alternative, for example, a canister may containa larger quantity of medications of a type to be dispensed to more thanone resident in an area served by the dispensing machine. The dispensingmachine provides for secure storage, convenient packaging, and accuratedispensing of prescription medications on schedule, “STAT”(immediately), or on demand (also referred to as “PRN” or as theresident or patient requests), automatically or under computer control,under the supervision or administration of a director of nursing in thetypical facility.

FIG. 5 illustrates a general system block diagram according to oneembodiment of the present invention. A hosting center 84 is shown thatincludes a main server 86 and a resource center (ORC) 88. The mainserver 86 operates an order management system (OMS) 90. The main server86 further includes a main database 114 coupled thereto. The ordermanagement system 90 is a comprehensive software system that runs on themain server 86 and includes a suite of interfaces to a number of otherfunctional units of the system, in addition to the communications andother housekeeping operations provided for in the order managementsystem 90. The main server 86, order management system 90, and database114 together form the operating hub of the prescription drug orderingand dispensing system of the present invention. The resource center 88is coupled to the main server 86 and provides a website presence for thefunctional units of the system to deposit and obtain informationconcerning operations of the system. These units typically are locatedin the hosting center 84, which in general may be provided by firmsoutside of and not otherwise connected or related to the health carefacilities or pharmacies participating in the dispensing systemdescribed herein.

Communication between the main server 86 and the functional operatingunits of the system occurs in the illustrative embodiment throughconnections to a global communications network 82 such as the Internet.The other principal functional operating units of the system coupled tothe network 82 include one or more pharmacies 92, designated as pharmacy1, pharmacy 2, etc., and pharmacy P; and one or more long term care(LTC) facilities 94, designated similarly as LTC 1, LTC 2, etc., and LTCQ. Long term care facilities 94 have been selected in this exemplarysystem to illustrate the principle concepts disclosed herein. Personsfamiliar with the prescription drug processing and delivery systems incurrent use will appreciate the generality of the concepts describedherein and recognize their applicability to other types of residenthealth care facilities such as nursing homes, assisted living centers,rehabilitation facilities, and even prison systems where health care isprovided. All of these functional operating units coupled to the network82 are equipped with communications interfaces to enable the requiredexchanges of data and commands for the system to perform its operations.

Each LTC facility 94 preferably includes a director of nursing oradministration 96, which may be represented by a workstation PC (notshown), an automated prescription drug dispensing machine (ADM) 100, anda kiosk 102 coupled directly to the ADM 100. As will be described, thekiosk 102 may be a workstation having a PC with display and a scanningdevice, and perhaps a server, database, printer, etc. in each LTC 94.

FIG. 6 illustrates a system block diagram according to a variation ofthe embodiment of FIG. 5, wherein further details of the pharmacy 92 anda long term care facility 94 in a typical system according to thepresent invention are illustrated. The network 82 and the hosting center84 containing the operating units of the main server 86, database 114,resource center 88, and the order management system 90 are asillustrated in FIG. 5. The pharmacy 92 in this embodiment may include apharmacy management system 122 and a pharmacy information system 124,each coupled to the other and operated by software applications residingon their respective PCs or server. Each of these units may beindependently coupled via the network to the main server 86 as will bedescribed. The operative portion of the long term care facility 94 isits prescription drug dispensing system 98. The dispensing system 98includes the automated dispensing machine 100, the kiosk 102 coupled toit that may include an eMAR server 104 operating on the kiosk, alongwith the other components mentioned for the embodiment of FIG. 5,including an auxiliary database 116, a work station with display, ascanning device, etc. FIG. 6 also depicts a LTC Director of Nursing workstation 96, which may be coupled directly to the resource center website88 via a link 110 through the network 82. A long term care facility 94may include a plurality of automated dispensing machines 100, each underthe control of a respective kiosk 102 or a PRN dispensing eMAR 106—alaptop PC or handheld computer (alternately, slave kiosk)—as shown, eachof which is connected to the eMAR server 104 at a kiosk 102 via a localcommunications bus 112, which may be internal to the dispensing system98. Connected to the same communications bus 112 may be additionalhandheld or tablet PCs 108. These multiple ADMs 100 and PCs 106, 108 maybe needed in larger resident patient facilities. Thus, the system can bescaled to include operation with a plurality of dispensing machines 100from, for example, a single kiosk having a workstation or eMAR server104, auxiliary database 116, scanning device, etc., as illustrated andwill be more fully described regarding FIG. 8 herein below.

FIG. 7 illustrates in schematic form a system block diagram of the basicarchitecture of one illustrated embodiment disclosed herein. The unitsrepresented by block outlines are essentially software providing variousfunctions operating within the system, including communication of datavia their respective connections to the network 82 as described.Functional units depicted as a block having a bold outline containsoftware written especially for the present invention. Further, it willappreciated that the order management system 90 is an essential andcentral piece of the system because it provides the overall managementand control of the system; that is, it integrates the functions of allthe operating units connected to the order management system 90 into theseamless operation necessary to provide an efficient and responsiveprescription drug dispensing system that overcomes the inefficienciesand inadequacies of the prior art dispensing methods. These advantageswill become apparent in the description that follows. The software ofthe various operating units runs on various PCs or servers as describedfor FIGS. 5 and 6. In one section of FIG. 7 several functional units aresurrounded by a dashed line and designated “Client Facing Systems.” Thismeans these units are located in or accessible from the long term carefacilities 94 via the network 82. Other functional units are located ina pharmacy system 92, which may be located either outside the long termcare facility 94 or within the LTC facility. Still other functionalunits may typically be external to the system because they representother entities with which the present system interacts, such as theprescription drug plans 128 and wholesaler systems 130.

Continuing with FIG. 7, the order management system 90 includes thefollowing interface programs for communicating with the various externalfunctional units in the long term care facility 94 (or facilities 94) orelsewhere. As shown in the drawing, each of these interface programsconnects to communication links with other interface programs internalto the order management system 90, or with functional operating unitsoutside the order management system 90 via communication through thenetwork 82. These links are designated with capital letters andnumerical symbols as shown in FIG. 7. A dispensing interface 140 islinked via the link C1 to the prescription order entry (POE) 120 and tothe eMAR interface 142 respectively in the order management system 90and the order dispensing system (ODS) 102 in the LTC 94 via a link D1.The eMAR interface 142 is further coupled with the eMAR functional unit104 in the LTC via link H1 and also to the resource center (ORC) 86 andthe billing interface 152 internal to the order management system 90 viathe link E3.

Further in the order management system 90 is located a reportinginterface 144 that is connected via the link E1 to the resource center86 and via the link J1 to a pharmacy management system (OPS) 122. Anadministration interface 146 in the OMS 90 is connected via the link E2to the resource center 86 via the link E2 and to the pharmacy Managementsystem 122 via the link J2. The billing interface 152 is also connectedvia the link G1 to a pharmacy information system (PhIS) 124. Thewholesaler interface 154 is shown coupled to the pharmacy managementsystem 122 via the link J3 and to one or more wholesaler systems 130 viathe link

Kl.

Continuing with the OMS 90 interfaces, a formulary benefits interface156 is coupled via the link M1 with the prescription drug plans (PDPs)128 and vis the link C2 with the prescription order entry functionalunit 120. An electronic health record (EHR) 158 is connected via a linkF1 and the network to an EHR 126 in the long term care facility 94, andto the prescription order entry (POE) unit 120 via the link C3.

The foregoing lines of communication identified by the letters C, D, E,F, G, and H (including C1, 2, 3; D1; E1, 2, 3; F1; G1; and HD betweenthe order management system 90 and the functional units across thenetwork 82 form a combination not known to exist in the prior art. Thatis, management and control of these on site functional units in a healthcare facility, via communication over a network such as the Internetfrom an off-site main server 84 running a suite of software such as theorder management system (OMS) 90 of the present invention is not knownto exist prior to the invention thereof as disclosed herein. There aremany benefits to this architecture as will become clear in thedescription which follows.

Further, the on-site communication links identified as the order entrybus A and the eMAR bus B, respectively connecting the order dispensingsystem (ODS) 102 with the prescription order entry unit 120 and theelectronic medication administration record (eMAR) 104 form a structureunique to prescription dispensing system in use in resident health carefacilities. These linked-together functional entities in the health carefacility provide substantial enhancements to the efficiency and accuracyof the administration of prescription medications in health carefacilities that provide health care to their residents in addition totheir other basic needs. Providing the benefits of this novelcombination of communication capabilities required substantial softwareinnovation to overcome obstacles that have stood in the way of achievingthese improvements until the insights leading to the present invention,even despite the existence of automated dispensing machines, whichhereto fore had been limited to basic, stand alone operation requiringsignificant human intervention to ensure accurate and timelyadministration of medications, without the benefits of linking theiroperation to the other functional entities involved in the dispensing ofprescription drugs under machine control.

FIG. 8 illustrates an automated prescription dispensing machine and anassociated work station according to the present invention for use withthe embodiments of FIGS. 2 through 7. Depicted in the drawing are anautomated prescription drug dispensing machine 100 and a kiosk 102coupled together by a communications bus 190 for conveying both controland data between these units. The kiosk 102, in one form as a cabinetbut which could as easily be a desk or table, supports a workstation orPC 160 having a display and other well-known attributes of a PC.Connected to the workstation may be a scanning device 162 such as a barcode scanner as shown in the present illustrative embodiment. Thescanning device 162 may be used for scanning encoded indicia printed ona canister label or a medication package label or any otheridentification data printed in documents, personnel ID cards or badges,for example. Other devices having the ability to scan and read an image(visual or audible) or data, including similar functional devices notyet invented, may be used. The kiosk 102 may further support a server104 or a printer 164, or other apparatus including software applicationsthat may be added or used to upgrade the dispensing capability of thesystem. One item that may be included in the arrangement of equipmentsupported in the kiosk 102 is an auxiliary database 116 as shown in FIG.6 herein above. An auxiliary database 116 may be used to store dataparticular to one automated dispensing machine or one group of machinesamong a plurality of dispensing machine groups in a health carefacility, in order to realize operating efficiencies or otheroperational improvements to the system.

Continuing with FIG. 8, an automated prescription drug dispensingmachine (ADM) 100 is illustrated in simplified form with its cabinetdoor opened to reveal banks 170 of dispensing canisters 172 therein. Thecanisters may be as described in FIGS. 3 and 4. After canisters 172 areloaded with the medication and are ready for dispensing, they may beplugged into one of the canister banks 170 in any open position.Mechanisms (not shown) within the ADM 100 cabinet provide for dispensinga unit of medication into a package prior to ejection from the machine.An ejection port 178 is provided in a convenient location on thedispensing machine 100. The ejection port 178 includes an opening fromwhich a strip of medication packages 180 is fed under machine control.The strips of transparent packages may include a printed label 182 andmay be separated by cross-wise perforations 184 to enable separating thepackages prior to administration to a resident.

FIG. 9A illustrates a first portion of a flow chart 200 for the basicoperation to provide for ordering and dispensing a prescription drug ina long term care facility by the system whose architecture isillustrated in FIG. 7. The steps will include references to the unit ofthe system, as shown in FIGS. 6 and 7, that is active or where the stepis carried out. The process begins at step 202 in which, both monthlyand for any new resident being admitted, the resident is entered intothe electronic health record (EHR) 126 and information regardingMedicare part D or Medicaid is verified and updated as necessary. Thisstep may be carried out in the long term care (LTC) facility 94. In thefollowing step 204, any new order for a prescription medication isentered at the prescription order entry (POE) 120 unit, which may belocated in the pharmacy 92, the LTC 94, or the office (not shown) of ahealth care provider. This step includes verifying third party payer(insurance or other health care benefit) coverage, checking for drugallergies of the resident and possible drug interactions with otherprescriptions the resident requires, and verifying that the newprescription is approved for dispensing at the order dispensing system(ODS) 98 on site at the LTC resident's location. The flow then advancesto step 206 to transmit the prescription order to the pharmacy 92 and toenter the information into the EHR 126 for the resident at the LTC 94.The EHR 126 may be located typically in the main database 114 at thehosting center 84 or the auxiliary database 116 associated with theorder dispensing system 98 at the LTC 94.

Continuing with FIG. 9A at step 208 the pharmacy 92 receives and reviewsthe order, then initiates formulary management processing to determinewhether the prescription requires a brand name (coded “B”) or brandedgeneric (coded “BG”) medication or a generic product (coded “G”) may besubstituted for the prescribed drug. Subsequently the order is submittedto the order dispensing system (ODS) 98 through the order managementsystem (OMS) 90 to process the filling of packets preparatory todispensing as will be described in FIG. 11 to follow. After step 208,the process advances to step 210 in which the OMS 90 notifies theprescription order entry (POE) 120 when the order has been approved by apharmacist. Then, the order data is stored in the main database 114, andthe OMS 90 determines the destination LTC 94 and the order dispensingsystem 102 to receive the order, and the order is queued for dispensingat the designated ODS 98 in the LTC 94. At the ODS 98 in step 212 theorder proceeds to step 216 for delivery to the ODS 98 and installationinto the automated dispensing machine 100 for dispensing andadministering at the next scheduled time. The ODS 98 stores all of theidentification and script data at the kiosk 102, then notifies the POE120 that the order is queued for dispensing. Step 216 just describedproceeds to step 222 along the path “A” in FIG. 9A, to FIG. 9B to bedescribed next.

FIG. 9B illustrates a second portion of the flow chart for the basicoperation of the system of FIGS. 6 and 7. Dispensing of medicationsoccurs according to a predetermined schedule within the daily routine ofthe long term care or other health care facility. In the illustratedexample the operation of the dispensing process may be initiated andcontrolled from the workstation 104 at the kiosk 102 associated with thedispensing machine 100 that will be utilized. The dispensing andadministering of the medications may generally be carried out by amedical aide or assistant under the supervision of the director ofnursing 96 or other registered nurse at the LTC 94. In step 222 thesystem awaits entry of a request from the ODS 98, sent by the electronicMedical Administration Record or eMAR 104 that the schedule calls fordispensing and administering of medications at a scheduled time.Accordingly, in step 224 the medical aide or assistant will operate theautomated dispensing machine (ADM) 100 to package and dispense one ormore packages of medications to be administered at a scheduled time asdescribed further in FIG. 12. Typically, the ADM 100 will package aplurality of doses into a strip of separate packages separated byperforations. The doses in each successive package may then beadministered to one resident after another who reside in closeproximity, for example. Each administering of a dose is then recorded inthe eMAR 104 by the medical aide or assistant before proceeding with thenext dose. This action includes, step 226, notifying the OMS 90 that theadministering of the prescribed dose has been completed and the recordin the database 116 may be updated as depicted in step 228. At theconclusion of this process the OMS 90 notifies the pharmacy informationsystem (PhIS) 124 in step 230 that the billing process may be carriedout, after which the process ends in step 232.

FIG. 10 illustrates a flow chart of one embodiment of a process 280 forformulary substitution according to the present invention. It isdescribed elsewhere that configuring the canisters 50 at the pharmacy 92and utilizing a compact set of ID data in the canister memory chip 60provide very substantial improvements in operating and processing speed,efficiency, and error reduction in the prescribing and dispensing ofprescription medications in resident health care facilities. One of theexemplary enhancements is the ability to manipulate formularies andreconfigure the canisters accordingly, a capability that does not existwhen the canisters are configured by the canister manufacturer. All thatthe manufacturer can do is manufacture canisters for every type ofmedication, including the wide variety of formularies that areavailable. In the present invention, in which the canisters can beconfigured by the pharmacy, the canisters can be configured on the spotfor a particular formulary that is suitable to be dispensed to aresident, even when the pharmacy must respond in real timecircumstances. FIG. 10 illustrates a process by which this may beaccomplished in the system of the present invention.

The process for FIG. 10 begins at step 282 after advancing from step 208(see FIG. 9A) to perform the sub-process of formulary substitution, asubset of formulary management illustrated herein in the exemplarysystem. Recall that prescription medications are classified as branded,branded generic, or generic, depending on what source of manufacture maybe accepted for administering to the resident. Thus, the process opensin step 282 by determining the formulary requirement of the “script” andresponding to the query “Is order NDC available in the ADM inventory?”In other words, is this NDC stocked in the ADM 100? The script is astatement specifying the requisite formulary, the amount of the dose,how often and when the dose is to be administered. If the response instep 284 is YES, the script permits a substitution of “B,” “BG,” or “G,”then a list of the medications available having the same status orclassification will be displayed on the display of the workstation 160at the kiosk 102 to enable a selection to be made by the nurse in step286 and entered into the record, followed by step 288 to dispense theorder. The ODS receiving the order advances to step 290 to return tostep 210 in FIG. 9A. Returning to step 282, if the NDC ordered is notavailable in the ADM 100 inventory, the flow goes to step 292 to look upthe medication in a pharmacy substitution formulary and determine theappropriate grouping, B, BG, or G. Then, in the query step 294, if theoriginal NDC is within the same grouping as the NDC in the ADM 100inventory (a YES response), the flow advances to step 284 and proceedsas described previously. If, in step 294, the NDCs do not match becausethe formulary medication is not available in the ADM 100, then theprocess goes to step 296 to exit, and the process ends.

The automated dispensing machine (ADM) 100 as described previously is anautomated machine for packaging and dispensing prescription medicationsunder computer control. Medications for a supply of doses to be storedin the machine are deposited in individual canisters 50 as described inFIGS. 3 and 4 herein. A typical ADM 100 may contain approximately 200canisters, for example. The actual number depends on the volume of themain body of the canisters, which may vary depending on the size andform of the individual does to be contained in the canister 50. Thesupply quantity of medications for an individual canister 50 may bedetermined by the needs for some interval of time, e.g., one month, orby the needs for one or more residents in the LTC 94. The processes forconfiguring, filling, and changing the contents of the canisters isillustrated in FIGS. 11A through 11F.

FIG. 11A illustrates a flow chart 240 of initial steps to begin amedication canister configuration and fill process according to oneembodiment of the present invention. The flow begins at user log in atstep 242 and the display of a menu of actions that involve theconfiguration, filling, or modifying the fill or information affectingthe canisters in step 244. In step 246 the user may select the desiredaction from the menu, which lists five different actions, respectively:create canister build; configure canister; fill canister; add medicationto the canister; and edit the medication information of the canister.These actions are respectively designated as steps 250, 252, 254, 256,and 258. Selecting any one of these options directs the user alongrespective paths B through F of FIG. 11A to corresponding processesillustrated in FIGS. 11B through 11F to be described herein below.

FIG. 11B illustrates a flow chart of a process to create a canisterbuild according to the present invention. A canister build is theprocess for configuring a canister for a specified medication. Asdescribed in FIGS. 3 and 4, the configuration of a canister may beadapted to the quantity, size, and shape of the individual doses of themedication to be stored or contained therein. The flow enters step 260from path B, displays build parts on a displayed page, and enablesselection of build parts appropriate to the prescription order beingfulfilled. Following the selection of parts, a query step 262 as towhether the needed information is complete provides a YES alternative tostep 264 to display a medication association input and select themedication that is to be deposited into the canister. Step 262 alsoprovides a NO alternative to return to step 260 if the information isnot complete. Following the selection of medication(s) for deposit intothe canister in step 264, the process advances to step 266 to log theinformation about the canister and provide for the user's manual inputof information about the canister build. In the following step 268, thecanister build manager is notified of the new canister configuration instep 268. Next, if there are any additional canister builds to process,as queried in step 270, the flow returns to step 260; if not, the flowends at step 272.

FIG. 11C illustrates a flow chart of a process to configure a canisteraccording to the present invention. The flow enters step 310 from pathC, displays a scan/manual input page to enable the user to enter or scanthe NDC for the prescription medication, and look up the NDC informationin the main database 114 or, in some cases, the auxiliary database 116as shown in FIG. 7. If the information sought is in the database (YES,in step 312), it is displayed in step 314, followed by a check query“Data Correct?” in step 316, and if YES to that query, advances to step318 to display the canister information. If the canister is to be filledwith the designated quantity, the YES response to the query in step 320is entered and the process exits to path D to be described in FIG. 11D.Returning to step 312, if the response to the query “Is the NDC data inthe database?” is NO, the process also exits to path D. Further, in step316, if the response to the query “Is the data correct?” is NO, then theflow exits to path F to be described in FIG. 11F. Returning now to step320, if the response to the query “Fill canister?” is NO, then the flowproceeds to step 322, a query as to whether any additional canisters areto be filled. If YES, the flow returns to step 310; if NO, the processends at step 324.

FIG. 11D illustrates a flow chart of a process to fill a canisteraccording to the present invention. Canisters are generally filled at apharmacy 92 that stocks the medications and is under the supervision ofa registered pharmacist as required by law. The present inventionincludes the ability to configure the canisters 50 at the pharmacy 92,at the time the canister is to be filled. In conventional systems theconfiguration of the canisters is accomplished to order by the canistermanufacturer before shipment to the pharmacy operator. The pharmacy muststock all of the different configurations of the canisters that it needsto fulfill orders for the prescription medications from the long term orother health care facilities that it services. Because of the very widevariety of formularies, forms, shapes and sizes of the medications, thepharmacy must maintain an extensive and expensive inventory ofconfigured canisters. The present invention overcomes this problem bystocking the interchangeable component parts of the canisters—a muchsmaller number of SKUs (stock keeping units). The efficiencies gainedfrom this technique are substantial because each canister can beconfigured as needed, thus avoiding the inventory of configuredcanisters not being used. Further, canisters can be readily modifiedfrom one configuration to another with minimal effort, thus minimizingthe likelihood that a dispenser is out of service because a particularcanister is not available. Moreover, quality control, inspection, repairand maintenance operations are significantly more efficient and lesslikely to cause delays because all of these operations can take place atthe pharmacy where the canisters are configured or filled.

Continuing with FIG. 11D, the flow begins on path D to step 330 toobtain and fill a canister, the user logs in to the system, selects“canister fill” on the workstation screen, and places the canister 50 ona chip writer (not shown). As shown in FIGS. 3 and 4, the canistermemory chip extends slightly below the underside of the canister 50,enabling it to be inserted into a receptacle on the chip writer forwriting the data thereto. In the next step, the system queries the userto ascertain whether the user is a registered pharmacist. If YES, theprocess advances to step 334 to display the scan/manual input page,wherein the user may select which of these modes—scan or inputmanually—will be used. If scan is selected a scanning device such as(but not limited to) a bar code scanner may be used. In the next step336 the system determines whether the user has a bottle of themedication to be utilized, and if YES, the flow goes on to step 342. If,however, the user does not have a bottle, the flow advances to step 338to scan or input the NDC, the Nation Drug Code, to the system, followedby the step to look up the NDC in the database 114. Returning to step332, if the user is not a pharmacist, the system displays the scan inputpage on the screen of the workstation in step 340 before advancing tostep 342 to scan the medication for its NDC.

Following step 344, the system determines whether the NDC is found inthe database 116? If NO, the process exits along path E to FIG. 11E. IfYES, the process steps to step 348 to determine whether the canister isOK for NDC, that is, whether its configuration matches or is compatiblewith the drug attribute information for the particular pill, capsule,tablet, etc. If YES, then the flow advances to step 350 to display themedication information to be written into the database and the build IDand Canister/Fill Ids written onto the canister memory chip. If thisinformation is NOT correct, then the process at step 352 exits alongpath F to FIG. 11F to edit the information. Returning to step 352 if theinformation is correct, the process proceeds to step 370 in which theLot Number, expiration information, and the registered pharmacistinformation is input to the system, followed in step 372 by writing thecanister information and printing the canister label. Next, the flowadvances to determine whether additional canisters need to be filled instep 374 and if the response is NO, the process ends at step 366. If theresponse is YES, the process prepares to place another canister on thecanister chip writer in step 376 and then flows back to step 332 tore-enter the fill processing procedure.

Returning to step 348, if the canister is determined to NOT be suitablefor the NDC that the user wishes to deposit in the canister, then theflow proceeds to step 360 wherein the system displays the error. Theuser has an option to return to the “Canister Lookup” step 318 in FIG.11C or select a manual override as in step 362. If the “manual override”is selected at 362, the system will send a notification of the error andthe manual override to the canister build center in step 364 beforeending the routine in step 366.

FIG. 11E illustrates a flow chart of a process to add a medicationcanister according to the present invention. Entry to the processproceeded along path E following selection in step 246 of the action to“Add Medication” at step 256. At step 390 the display screen for addinga medication appears on the workstation display, enabling the user toinput the medication data in step 392 in the respective fields for themedication to be added. This information may include for example amnemonic, the NDC, the name of the drug, its strength, unit,manufacturer, color, shape, marking, and schedule for administering. Theadded information is logged and the user input manually in step 394,followed by step 396 to notify the canister build manager regarding theadded medication. Next, in step 398 a query occurs whether there are anyother additional medications to input. If YES, the flow returns to step390 and the process repeats; if NO, the process ends.

FIG. 11F illustrates a flow chart of a process to edit a medicationcanister according to the present invention. It is similar to theprocess for adding a medication and proceeds as follows. Entry to theprocess proceeded along path F following selection in step 246 of theaction to “Edit Medication” at step 258. At step 410 the display screenfor editing a medication appears on the workstation display, enablingthe user to input the medication data in step 412 in the respectivefields for the medication to be added. This information may include forexample a mnemonic, the NDC, the name of the drug, its strength, unit,manufacturer, color, shape, marking, and schedule for administering. Theedited information is logged and the user input manually in step 394,followed by a query step 416 whether the size or shape of the medicationunit is to be edited. If YES, the flow proceeds to step 418 to notifythe canister build center regarding the edited canister; if NO, the flowadvances ahead of step 418 to another query step 420 whether there areany additional medications. If YES, the process returns to the step 410to repeat the edit routine. If NO, the process ends.

FIG. 12 illustrates a flow chart of a process 430 to prepare medicationsfor administering them to residents of a long term care facilityaccording to the present invention. The first step 432 occurs as thenurse logs on to the order dispensing system (ODS) 98 at the kiosk 104(See FIG. 8) and selects Order, then the Dispense option displayed onthe workstation screen of the kiosk 104 to display active patient orresident orders. Then in step 434 the nurse selects an order to bedispensed, approves a prompt to confirm by selecting the Dispenseoption. Next, in step 436 the ODS 98 processes the request, sorts themedications, sends dispensing information to the packager in theautomated dispensing machine (ADM) 100. Upon receiving the dispensinginformation the packager, in step 438 packages selected medications in aseries of individual packets delineated by cross-ways perforations tofacilitate ease of tear-off separation, and outputs the packets from theport 178 on the ADM 100. The nurse or assistant may then remove thestrip of packets from the ADM 100 in step 440 and place the strip 180 ona medication cart (not shown) for delivery to residents scheduled toreceive the medications in the strip 180 of packets. In the last step442 the medications are administered to residents according to the eMARas will be depicted in FIG. 13 to follow.

FIG. 13 illustrates a flow chart of a process 450 for administeringmedications to residents of a long term care facility according to thepresent invention. The process begins at step 452 in which an assistantselects a resident on a display of a workstation to display themedication(s) to be administered. Next, in step 454 the assistant scansthe medication packet to verify the packet contents are appropriateaccording to the database record as shown on the display. Then the flowproceeds to step 456 to administer the medication, select the actionperformed to confirm the administering of the medication. The processcontinues at step 458 with an opportunity to record additionalinformation as appropriate, and concludes with a query step 460 whetherthe medication last administered is the last resident in the scheduledsequence? If the result is YES, the process ends; if the result is NO,the process returns via step 464 to the beginning of the process 450 atstep 452.

FIG. 14 illustrates a simplified flow diagram 470 for reading medicationdata from a canister memory 60 according to the present invention tohighlight the reduction in processing and dispensing time, and errors indispensing afforded by the modified memory contents. Beginning at step472, the canister 50 is placed on a base in the ADM 98 that contains akeyed receptacle (not shown) that matches the guide block 80 (See FIG.4) on the underside of the canister 50. In step 474 the Build ID andCanister/Fill ID data (18 bytes total) are read. At this point theprocess follows two parallel paths simultaneously. Before proceeding,some terms need to be defined. A “canister movement log” contains dataabout the canister 50 that tracks the historical position of thecanister 50 in the Automated Dispensing Machine (ADM) 100. “Canistermovement data” represents the contents of the database where themovement data is stored. “Canister/fill data” represents the contents ofthe database where the canister/fill data is stored. “Fill data” is thedata associated with the Fill ID of the canister.

Continuing with FIG. 14, advancing from step 474 proceeds along twoparallel paths. In a first path, the flow advances to step 478 to storethe canister ID and ADM 100 position data (the location in the ADM ofthe canister) in the movement log database. Step 480 represents thestored movement log data in the auxiliary database, which may reside inthe server 104 or the workstation 160 at the kiosk 102, and the processends at step 488. In the second path following step 474, thecanister/fill ID is looked up at step 482 in the kiosk database, whichis synonymous with the auxiliary database 116 in FIG. 6. Then thecanister position data representing the canister's position in the ADM100 is updated in the kiosk or auxiliary database 116. Step 486represents the updated canister/fill data in the auxiliary database 116,and the process ends at step 488.

While the invention has been shown in only several of its forms, it isnot thus limited but is susceptible to various changes and modificationswithout departing from the spirit thereof.

What is claimed is:
 1. A drug management system for initiating andtracking dispensation and administration of medications to individualpatients, the drug management system comprising: an order managementsystem configured with one or more processors associated with one ormore servers, the order management system in communication with one ormore networks and operable to receive at least a portion of a firstpatient specific medication order for a first patient and a firstmedication, and further configured to: communicate through the one ormore networks a first dispensation action of the first medication,communicate through the one or more networks a first administrationaction of the first medication to the first patient, store a firstelectronic record associated with the first medication for the firstpatient, the first electronic record being capable of storing the firstdispensation action for the first medication, and being capable ofstoring the first administration action of the first medication to thefirst patient, a first medication dispensing system located at a firstfacility, the first medication dispensing system configured with the oneor more processors, and in communication with the order managementsystem through the one or more networks, the first medication dispensingsystem further configured to: receive a first request to dispense thefirst medication associated with the first electronic record, releasethe first medication associated with the first request, enabled by afirst automated medication packaging and dispensing machine (first ADM)that includes a plurality of canisters retained in the first ADM duringoperation and containing and being coded for a particular medication, atleast one canister coded for the first medication being initiated by thefirst request to release at least one of the first medication containedtherein, package the released at least one of the first medication forthe first patient into at least a first package after release by thefirst ADM, dispense, after packaging, at least the first package for thefirst patient by the first ADM, update the first electronic recordassociated with the first patient to indicate that the packaged anddispensed first medication in accordance with the first request has beendispensed, update the first electronic record associated with the firstpatient to indicate that the packaged and dispensed first medication forthe first patient, packaged and dispensed in accordance with the firstrequest, has been administered to the first patient, and store theupdated first electronic record, wherein the first ADM generates anidentifier on the at least the first package, the identifier forassociating the packaged and dispensed first medication with the firstpatient, and with the first patient specific medication order, and forproviding information to the first electronic record wherein the firstmedication for the first patient is releasable from more than onecanister.
 2. The drug management system of claim 1, wherein the ordermanagement system is configured to generate at least the firstelectronic record associated with the first patient, wherein the firstelectronic record is at least partially based on the at least a portionof the first patient specific medication order, and wherein the firstelectronic record is configured to include information regarding: (i)dispensation actions of the first medication, and (ii) administrationactions of the first medication, the administration actions of the firstmedication associated with an administration schedule of the firstmedication for the first patient.
 3. The drug management system of claim2, further comprising an order entry system configured to: receive thefirst patient specific medication order for the first patient and thefirst medication, communicate at least a portion of the first patientspecific medication order through the one or more networks, receive asecond patient specific medication order for a second patient and asecond medication, and communicate at least a portion of the secondpatient specific medication order through the one or more networks;wherein the order management system is configured to generate at least asecond electronic record associated with the second patient, wherein thesecond electronic record is at least partially based on the at least aportion of the second patient specific medication order, and wherein thesecond electronic record is configured to include information regarding:(i) dispensation actions of the second medication, and (ii)administration actions of the second medication associated with anadministration schedule of the second medication for the second patient.4. The drug management system of claim 3, wherein the order managementsystem is further configured to: communicate through the one or morenetworks at least a first dispensation action of the second medication,communicate through the one or more networks at least a firstadministration action of the second medication to the second patient,and store the second electronic record associated with the secondmedication for the second patient, the second electronic record beingcapable of storing the at least the first dispensation action for thesecond medication, and being capable of storing at least the firstadministration action of the second medication to the second patient. 5.The drug management system of claim 4, further comprising: a secondmedication dispensing system located at a second facility, the secondmedication dispensing system configured with the one or more processors,and in communication with the order management system through the one ormore networks, the second medication dispensing system furtherconfigured to: receive a second request to dispense the secondmedication associated with the second electronic record, release thesecond medication associated with the second request, enabled by asecond automated medication packaging and dispensing machine (secondADM) that includes a plurality of canisters retained in the second ADMduring operation and containing and being coded for a particularmedication, at least one canister coded for the second medication beinginitiated by the second request to release at least one of the secondmedication contained therein, package the released at least one of thesecond medication for the second patient into at least a second packageafter release by the second ADM, dispense, after packaging, at least asecond package for the second patient by the second ADM, update thesecond electronic record associated with the second patient to indicatethat the packaged and dispensed the second medication in accordance withthe second request has been dispensed, update the second electronicrecord associated with the second patient to indicate that the packagedand dispensed the second medication for the second patient, packaged anddispensed in accordance with the second request, has been administeredto the second patient, and store the updated second electronic record.6. The drug management system of claim 3, wherein the identifier is oneor more from a group that includes a bar code, an optical code, aprinted element, a badge, a label, a magnetic element, and a readableimage.
 7. The drug management system of claim 1, wherein the firstmedication is in a form of at least one individual pill, individualtablet, individual caplet, or individual capsule.
 8. The drug managementsystem of claim 1, wherein the update of the first electronic recordassociated with the first patient includes recording a time the packagedand dispensed first medication is dispensed, and recording informationassociated with identity of a health care professional initiatingdispensation of the packaged and dispensed first medication.
 9. The drugmanagement system of claim 1, wherein the update of the first electronicrecord associated with the first patient includes recording a time thefirst medication is administered, and recording information associatedwith identity of a health care professional administering the packagedand dispensed first medication to the first patient.
 10. The drugmanagement system of claim 1, wherein one or more canisters furthercomprise at least a canister code to identify a particular canister. 11.The drug management system of claim 1, wherein one or more canistersfurther comprise at least a canister code to identify the particularmedication contained therein, the canister code based in part ondimensional attributes of a particular medication type containedtherein.
 12. The drug management system of claim 1, wherein the one ormore processors of the first medication dispensing system located at thefirst facility are at least a portion of the first ADM.
 13. The drugmanagement system of claim 1, wherein the first facility is a healthcarefacility having associated with at least the first medication dispensingsystem at least one database in operable communication with the ordermanagement system via the one or more networks.
 14. The drug managementsystem of claim 1, wherein the first facility is a retail facilityhaving associated with at least the first medication dispensing systemat least one database in operable communication with the ordermanagement system via the one or more networks.
 15. A method forinitiating and tracking dispensation and administration of medicationsto individual patients, the method comprising: receiving at least aportion of a first patient specific medication order at an ordermanagement system accessible through one or more networks; generating,via one or more processors associated with one or more servers, at leasta first electronic record associated with a first medication for a firstpatient, and based at least in part on the at least a portion of thefirst patient specific medication order, wherein the first electronicrecord is accessible through the one or more networks, and includesinformation regarding: (i) dispensation actions of the first medication,and (ii) administration actions of the first medication to the firstpatient; storing the at least the first electronic record associatedwith the first medication for the first patient at an order managementsystem; transmitting instructions from the order management system, theinstructions configured to cause a first medication dispensing systemconfigured with the one or more processors to: dispense, by a firstautomated medication packaging and dispensing machine (first ADM), thefirst medication in one or more first packets in accordance with the atleast the first electronic record associated with the first patient andthe first patient specific medication order; generate, by the first ADM,an identifier on the one or more first packets, the identifier forassociating the dispensed first medication with the first patient, andwith the first patient specific medication order; and update the atleast the first electronic record to indicate dispensing of the one ormore first packets; and updating the at least the first electronicrecord upon administration of the one or more first packets to the firstpatient, the updating indicating administration of the first medicationcontained in the one or more first packets to the first patient, andwherein the first medication for the first patient is releasable frommore than one canister.
 16. The method of claim 15, herein the first ADMincludes a plurality of canisters retained during operation in the firstADM, and containing and being coded for a particular medication, inwhich a canister coded for the first medication for the first patient isconfigured to release the first medication in a form of at least oneindividual pill, individual tablet, individual caplet, or individualcapsule.
 17. A first medication dispensing system configured with one ormore processors, and in communication with an order management systemthrough one or more networks, the first medication dispensing systemfurther configured to: receive a first request to dispense a firstmedication associated with a first electronic record; release the firstmedication associated with the first request enabled by a firstautomated medication packaging and dispensing machine (first ADM) thatincludes a plurality of canisters retained in the first ADM duringoperation and containing and being coded for a particular medication, atleast one canister coded for the first medication being initiated by thefirst request to release at least one of the first medication containedtherein; package the released at least one of the first medication for afirst patient into at least a first package after release of the firstmedication associated with the first request by the first ADM; generate,by the first ADM, an identifier on the at least the first package, theidentifier for associating the dispensed first medication with the firstpatient; dispense, after packaging, at least the first package for thefirst patient by the first ADM; update the first electronic recordassociated with the first patient to indicate that the packaged anddispensed first medication in accordance with the first request has beendispensed; update the first electronic record associated with the firstpatient to indicate that the packaged and dispensed first medication forthe first patient, packaged and dispensed in accordance with the firstrequest, has been administered to the first patient; and store theupdated first electronic record, wherein the update of the firstelectronic record associated with the first patient includes recording atime the packaged and dispensed first medication is dispensed, andrecording information associated with an identity of a health careprofessional initiating dispensation of the packaged and dispensed firstmedication, and wherein the update of the first electronic recordassociated with the first patient includes recording a time the firstmedication is administered, and recording information associated with anidentity of a health care professional administering the packaged anddispensed first medication to the first patient.
 18. The firstmedication dispensing system of claim 17, wherein the first medicationfor the first patient is released from more than one canister.